Abstract: The surface of integrated channel systems is not smooth. The indentations, irregularities and bifurcation inside and at the exits of the channel systems are weak points, where fresh patient material (blood and tissue) remains. Biofilm-formation on the surface is the matrix for microbial growth. Endoscopists must be aware of this risk. The use of 10.000 pixel optics to check the channel system and to control the surface with the microscope should be a requirement in daily practice.

The microbiological analysis alone is not sufficient. The combination of micro-endoscopy with a specified microbiological analysis or better with new techniques based on ATP monitoring or polymerase chain reaction may be the first step towards an improved control of the infection risk. The patients must be informed about these facts as well as the insurance companies in order to calculate the risk of endoscopy. The routine endoscopy with biopsy is the most common procedure and can be performed perfectly with a disposable system. Disposable tube systems connectable to a solid endoscope (without integrated channels) have to be available in order to avoid the risk. We want to ask the responsible companies in this field to collaborate. Endoscopy is an important tool and disposable tube systems at this moment are without any doubt the only safe way.

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